Loading...
HomeMy WebLinkAbout2527 . ~ . ' • ~ ~ _ _ _ . , . R~= ' ~"E ~+'d NEM JERSEY STATE DEPARTMENT ~ HEALTH ~ w.s , . - ` 4 TRENTON. N. ~ Fi1.~8 ~,ANO~p~Q~ ~ ~ ST. IUCI$ Cbt~iV~Y"~1 : , ~~t # - " RECORD VERIFI~D ~ . ~ ' _ ~ - ad~y T, lg7o ~96119 ~ - ~ 16 32 '-w+, ~';Yr~- . ~O ~ ~ . "1.~~: , ~r . ~ ; ~J ~ ~ h° i ~ ! .'i ~ ~ ; ~,rr • ~ ' ~ ~ EIZ . . . ~r. • , • ~ • - 7 THE fOLL01111NG li A TRUE COPY OF A RECORD fl MENT ` I~~ ~Ik ~ .,t..;;;;,~y~~.r~.~ s:'•, RK Cl}~! covRT~ ;:`~c i~ ~ . ~ ~ . ~/fi(~ ~ v '"-r ' ~~i~ y . i . State Regiatras o( Vital Seatislics State Co~iasiaeer oj Nealµ IMARNING: DO NOT ACCEPT THlS COPY UNLESS THE RAISED SEAL OF THE ~ STATE DEPARTMENT OF HEALTH IS AFFtXED HEREON. Msz.. - ~ IHN JERfEY iTATt DE~ARTM[11T Of M~AL.TN , ~a,w~~~Nw.sR ~ERTIFICATE Of DEATH :T~nrasNUwe~ ~ ~~c~ 1, HANE pp fPnst) lMiJA~) (l.a+~J 2. Sss 3. DATB OE DBA7H e[~o~ so~ pECE/ISEp 3TATE YSE rr,~,.,,,;,,, • • Y rL~cc 1. ~'.~Mr a R~ce 3. A~ fis ~n+. r 1 Yr U reder t/ Hn. b D~e o( Bin? 7. ~~s dscea~eJ s~ i~ L.S. MMd ~reet) ~i t6 l~s~ ii~~Nel1 s s il 1 lY~i, sa «r~Lew1 fl/ „s. ~ire nar M ru~a ~J ae?K1 61 ~ro si~eip+.ce tsur. o. f«ria svw~a) 9. c.k;s~. at .?~t oo~t.~l ~o. wrriea [7~ tic.et ~arriea p t~. s«ial see.rit~ ti.. _ - ~ ~tagis II.3.A. ~~.~ao °'.«"°o . ~cswcNCC PLACE OF DEA'IH 13. I15UAL ~ESDENCE (If iMCic.ciea: nside~ce befae c~r Passaic s~•~~ A. J. Pseasio w~n cceKt ~..a s~ cK, p cceK~ ~..a ~r.....~ T. U Pa8BSi0 ~"C7 Cli~ton - c. sei ~ « usnttica~ =ne suee~ s~ AdBtsu N ~rd. P.O. Addrt~t) ~ "e°,~'.~,~p; Bsth Iesael Hoepital 43 H~ ton 8oad ~ _ o- . a U rp~tio~ rwr ' ' ~atf i. tat~ i nf' . 8~ai~ss~ a~ ~ ; ~ Ho~seiwii~ 6 s. .deir•. N..e ~ Ibdet', N..R , ~ Abraham ~nb IInlaQawu 7. rd....~c~. M..e Aiie., ~ ~ I,son Blein 44 Hampton Bo~d Cli=tat?~ Hew Jerasy • c ~usf U. PART 1 DEATN ~AS CAlISEO SY 8~t~? a~ty aw caur ~!fiw /ar (~A MJ fe) Appw:IMte iacend bet~eh , M~at ~d ~e~ei ~ . ~I Ire~ine CMae '~.~/J - ~ G+Jfttwi. 1/~e~r• nift~ ~ , L~ - ~~r~r ris~ to ~M~ on+~ D~e a(N Y~1'. swtlq ti~ .~Irw ~ ~ i h j .7 " - C~-r~~~m~ c«. ~l'~ e~stt l~tf DK e~ ft) ~ w.w ~ ..tsur PART p O?HE1t SIGMEICANT COI~iW?10N5 - 19a. ~rl 19b. ~~e~. ~ae tLii~~ O?H t - Ye~ M~ Ye~ UN ' ~ v l ~ p~. ACC~l~t ~Itldf ~~~C~t atf Yd ~ mt. MJ~ ~CCl1~ ~ M/~I /A ~Ml / M Q ~ftU ~CC~ • !O dt kif 4~wr/ O IOl. hj~ Occ~roed 70e. Pl~es ~t Mj~r~r(e.~. 70f. Cigr. T~w ~r Loc~tiw Cw~e~ Satt i` ~Ui1e ~ Q 11~ ~iile p i~~7• +ar~t. e//!n ilJ~.. ~re.) , . 1wk ~t ~ - - c ~os~ c~~rs. 21. 1(~ne~/tJ. s:ri~e~~ft ~eew~ (1~. M) M ~i lart ~w ~u) ~lM w y. D~r? ~scv.~I r~' a~!w tae rwe! ~ ; ar M~ Mat q i~wr .~iw N~ aMa ~w~ ' ~ 2~.. A~'~rs. ~ te..ef pM• O Zs. ~ t~e• L~i T~ ~~~~uG~i~ . lt~r...u~~-~ ~ ~ t ~ _ ~ tl.. ~~r+a. c~...n{». c....~y. G..Mw~ M... . I..e.ti.~. ' uq tw. ' Yi Solooo~n C~ Cliftoa xs~r J~rs• tl/. tiw a.. w. a.~ rr. tb. r.Nrd w~e Itr.. 7~. ~~n11M~. A~i~. ' Ootob~r 2 1969 J~~wi~h Yevozial Chs ~l Sew~ A~u~ Paasaio, New J~ra~~ 'f a.K.d 6i. M. j. Lk.... w. qi...r b..i~ «.w - /l~s~1. c.«d ~ tf~ilp~! I'O ~ ~ ~ e. 9~ ~ ~ p~4~ ~ ,i~.~:.r~`:'~_a- ~~y ._X~,'~!. , - ' ' -